review of literature on clinical pancreatology - The Pancreapedia

Chronic pancreatitis is associated with a substantial morbidity, including malnutrition,malabsorption, pseudocysts, metabolic disturbances, and intractable abdominal pain.Approximately 5 percent <strong>of</strong> patients with chronic pancreatitis are refractory to nutritionalsupport and opiate analgesia, making management challenging. Pancreatic rest can providesymptomatic relief. However, achieving simultaneous pancreatic rest and adequatenutritional support in these patients is difficult. It was describe a technique for providingnutritional support and pancreatic rest in patients with intractable symptomatic in 3 patients.All 3 patients had masses associated with the pancreas. Symptom relief and adequatenutritional support were achieved by inserting a long-term nasojejunal tube (FlocareBengmark, Nutricia Clinical Care, United Kingdom) under ambulatory endoscopic guidance.The long-term nasojejunal tube feeding achieved pancreatic rest and significant symptomaticrelief while delivering adequate nutritional support. Pseudocyst size decreased substantiallyin 2 patients. The third patient was found to have pancreatic carcinoma afterpancreaticoduodenectomy [288].Influence <strong>of</strong> colostrumsExocrine pancreatic secretion contributes to limit pathogenic bacteria-associated diarrhea.Bovine colostrum, used in the treatment <strong>of</strong> diarrhea, reduces symptoms originating from gutpathogenic bacteria overgrowth. It was hypothesized that bovine colostrum may stimulate theexocrine pancreatic secretion. Eighteen piglets fitted with 2 permanent catheters (forpancreatic juice collection and reintroduction) were allocated to 1 <strong>of</strong> the following 2 dietarytreatments for 5 days: a control diet or a diet supplemented with defatted bovine colostrum.Pancreatic juice was collected daily, and digestive enzyme activities and antibacterial activitywere determined. The prandial pancreatic juice outflow, the basal and prandial lipase output,and the basal secretion <strong>of</strong> the antibacterial activity were, respectively, 60 percent, 154percent, 92 percent, and 72 percent higher in piglets fed a diet supplemented with defattedbovine colostrum. It was concluded that with defatted bovine colostrum, the increasedantibacterial activity secretion against Escherichia coli may limit pathogenic bacteriaovergrowth <strong>of</strong> the gut and reduce diarrheal episodes. The role <strong>of</strong> secretin in the increasedpancreatic juice flow and lipase secretion was considered [289].Diabetes in chronic pancreatitisIn consequence <strong>of</strong> the close anatomical and functional links between the exocrine andendocrine pancreas, any disease affecting one <strong>of</strong> these parts will inevitably affect the other.Pancreatic conditions which might cause diabetes mellitus include acute and chronicpancreatitis, pancreatic surgery, cystic fibrosis and pancreatic cancer. The development <strong>of</strong>diabetes greatly influences the prognosis and quality <strong>of</strong> life <strong>of</strong> patients with exocrinepancreatic diseases. It may cause lifethreatening complications, such as hypoglycemia, dueto the lack <strong>of</strong> glucagon and the impaired absorption <strong>of</strong> nutrients, or the micro- andmacrovascular complications may impair the organ functions. Temporary hyperglycemia canbe observed in around 50 percent <strong>of</strong> patients with acute pancreatitis; persisting diabetesmellitus may affect 1-15 percent. The prevalence <strong>of</strong> diabetes in chronic pancreatitis variesbetween 30 and 83 percent. Overall, exocrine pancreatic diseases are believed to beresponsible for diabetes in only about 0.5-1.7 percent <strong>of</strong> the cases, but in as many as 15-20percent <strong>of</strong> diabetes mellitus patients in Southeast Asia, where tropical pancreatitis isendemic. The incidence <strong>of</strong> pancreatic diabetes depends on several factors, such as theetiology and duration <strong>of</strong> chronic pancreatitis, and the presence <strong>of</strong> pancreatic calcification.The endocrine function is more disturbed in alcoholic chronic pancreatitis than innonalcoholic pancreatitis. Both insulin and glucagon secretion are more strongly impaired inpatients with calcified chronic pancreatitis than in those with noncalcified chronic pancreatitis.In two recent follow-up studies <strong>of</strong> patients with chronic pancreatitis over a period <strong>of</strong> 7.7 and 8